The therapeutic use of self: developing three capacities for a more mindful practice.

The relational aspect of care is as essential to the overall patient experience as the technical aspects of care. The relational aspect of care hinges on how the caregiver uses his or her self as an instrument of care. For caregivers to fully engage in the art of healing, they must be mindful of the self they are bringing to every encounter. This mindfulness can be strengthened through the thoughtful pursuit of self-attunement, self-clarity, and self-compassion.Keywords: therapeutic use of self; therapeutic relationship; self-compassion; selfattunement; self-clarity; reflectionLately, I find myself reflecting on what has influenced my life's work over the past 40 years and what has mattered most. I remember three women who had a profound influence in my formative years on my beliefs about nursing and caring for people. The woman who inspired me to go into nursing is a beautiful soul and a dear friend. I met Cathy Muntifering in my late teens at a time when nursing was the furthest thing from my mind. Cathy was a night supervisor at St. Cloud Hospital in Minnesota, and we spent hours at the kitchen table talking about her work and the people she helped get through the night-from distressed families to distressed patients and staff. What was clear to me in the stories she told was that it wasn't just what she did for the people in her care that mattered; it was the person of Cathy that made the difference when she was called to help. She was a calm, peaceful presence, and her energy and respect for those in distress comforted them and helped resolve some of the most difficult circumstances imaginable. When I was with Cathy, I experienced the same calm presence. I felt seen and respected by her, and I knew I wanted to pay that forward to others.The other two women who were particularly influential were my psychiatric and obstetrical nursing instructors at Central Texas College in Killeen, Texas. I began my career in an associate degree program that was taught by an inspiring and dedicated faculty. They never believed that nursing was only a technical field. Although they didn't use the word, they made clear that nursing was a relational field in which technical proficiency was also essential. These extraordinary teachers were pivotal in formulating my beliefs about what nursing practice is, what it means, and what it has to do with me. They taught me this simple principle-that my nursing practice is within me. The most important thing I bring to the people in my care is myself. They taught me that when I became a full-fledged, licensed nurse, I would be accepting the daunting and rewarding responsibility of being an instrument of caring and healing. They taught that the "therapeutic use of self" was the most important element of my practice.What I have grown to understand about all of this over the decades is that these women were teaching me about how important it is to be mindful and disciplined about myself, to have the energy, clarity, and focus necessary to engage in the complex work of caring for other human beings.I have written elsewhere about the importance of three key relationships in our practice: our relationship with ourselves, our relationships with our colleagues, and our therapeutic relationships with patients and their loved ones. In this article, I focus on what it takes to continuously care for and develop ourselves so that we are in the best position to engage in healthy relationships with our colleagues and those in our care. It seems clear that to be an instrument of caring and healing for others requires that we care for, know, and heal ourselves.Christiane Northrop, in her interview in this issue of Creative Nursing, talks about how addiction to rescuing others can drive the responsibilities we take on and the commitments we make, and ultimately hurt our well-being. As I speak with groups of people in health care, they confirm that it feels more natural to focus on the needs of others and on the work they need to get done than to pay attention to themselves-what they need, what they are feeling, how they are coping. …